Designing Thoracic Surgical Care That Works for All: A Quality Improvement Approach to Disparities

This article conceptualizes disparities in thoracic surgery outcomes as modifiable quality improvement failures that undermine reliability, timeliness, and effectiveness across the care continuum. It links inequities to upstream determinants, including differential tobacco exposure, environmental and occupational carcinogens, health literacy, and structural racism, which together influence risk and access to guideline-concordant care. The authors describe process failures in detection and referral-particularly low uptake of low-dose computed tomographic screening and delayed specialty consultation-that reduce surgical opportunity and contribute to later-stage diagnosis. Cumulative delays and geographic maldistribution of thoracic surgeons further exacerbate outcome gaps.